Percutaneous fixation of hollow organs

ABSTRACT

For percutaneous fixation of a hollow organ of a body, a hollow needle carrying a retaining device attached to a tension filament through the skin into the hollow organ, the retaining device is released from the needle, and the organ is fixed by adjusting the tension on the filament and clamping the filament outside the body by means bearing upon the exterior of the body.

.Iadd.This application is a reissue of Ser. No. 06/798,781 filed Nov.18, 1985, U.S. Pat. No. 4,705,040. .Iaddend.

In preparation for inserting a tube such as drainage or feeding tubeinto a hollow organ of the body, it is desired to fix the hollow organto a body wall. This aids in accurate placement of the tube and inpreventing leakage that can contaminate the peritoneal cavity and leadto peritonitus.

In the past, fixation of hollow organs has mainly been accomplished bysuturing during open surgery as part of the procedure of placing thetube. However, to avoid the drawbacks of incision, general anesthesiaand need for an operating room, it is desirable to accomplish the entireprocedure without surgery.

For this purpose, a technique has been used which obtains some degree offixation, particularly of the gastric wall to the body wall. A tube witha blunt end which is installed, in a retrograde manner from the insideof the stomach towards the outside, the blunt end of the tube engagingthe stomach wall and holding it in place. For this purpose, agastroscope is placed in the patient's stomach, a site is chosen on theskin using the light from the gastroscope, a puncture is made throughthe skin and a guidewire is introduced into the stomach. This guidewireis grasped by the gastroscope and pulled out of the stomach through theesophagus and out of the mouth. The end of the wire protruding from themouth is then attached to a tube, having a leading pointed end and atrailing blunt end. The guidewire is pulled back into the stomach andthe pointed end of the tube is pulled through the gastric wall and theskin until the blunt end of the tube is secured against the stomach andholds the stomach wall against the body wall.

The disadvantages of this technique are that it requires a biggastroscope which has inherent risks, it is not possible to employ agastroscope with all patients, and the tube is critically dependent uponits own fixation. If such tube were removed inadvertently, the fixationwould be lost, leaving an open hole in the stomach and no method offixation, with resultant leak into the peritoneal cavity.

Also in the prior art, but not to be confused with techniques whichachieve secure fixation of the wall of the hollow organ to the bodywall, are the uses of tubes which have ends of various designs toprevent inadvertent withdrawal of the tube itself. There are several ofthese, some of which are introduced percutaneously while others areutilized during surgical procedures. One is known by the nameMallincott, another is a balloon employed on the end of a Foleycatheter, and there are various looped catheters such as the Cope loop.Basically, the ends of these catheters prevent the catheter from beingwithdrawn and to some degree may serve to retain the hollow organ inposition against the body wall. However, in order to fix a hollow organwall in place one has to apply traction, but traction on the cathetertends, after a period of time, to pull the catheter out, and thereforethe needed degree of traction, for secure fixation, is incompatible withthe primary objective of such devices.

Objects of the present invention are to provide a device and method toobtain better fixation of hollow organs by techniques that do notrequire surgery.

SUMMARY OF THE INVENTION

According to the present invention, the task of fixation or anchoring ofthe hollow organ is separated from that of catheterization for drainageor infusion, and fixation is achieved by percutaneous placement of tackdevices.

According to the invention, a series of spaced apart tacks or retentiondevices are introduced percutaneously to the inside of the hollow organ,each associated with a filament-like tension piece which is used toapply fixation force, outside of the body by a device that bears againstthe exterior of the body. Preferably, the introduction is achieved byplacing a stiff T-shaped end of a tension filament within the lumen of aneedle and allowing the flexible filament to protrude from a small slotat the tip of the needle, with the filament trailing alongside duringintroduction. After the needle is passed through the skin and enters thehollow organ, a stylette or obturator is used to dislodge the head ofthe T piece from the lumen and the needle can be withdrawn. At thispoint tension is applied along the filament and the "T" head is urgedsnugly against the inside surface of the hollow organ and holds itthere. In practice, four needles may be employed to place four separateT-shaped devices. Preferably, the head of the T element is of the orderof a centimeter long and the filament is approximately 10 to 15centimeters long. In the case of the stomach, four of these tack devicesare placed at the corners of a one or two-inch square and then thefeeding tube is placed in the center of this square.

The head of the T is preferably an elongated cylinder, at the midportion of which is attached a filament of synthetic resin, the headbeing small enough to be introduced percutaneously and sufficientlystiff to prevent bending of the head so that it does not bend and pullout, and the filament being strong in tension and flexible enough tobend approximately 90° at its junction with the head of the T piece. Inthe presently preferred form, the head of the T element is aligned withthe axis of the needle and housed within it during insertion.

Preferably, the needle comprises conventional hypodermic tubing, 16gauge, regular or thin wall, the needle has a single bevel and the slotis cut from the more proximal surface of the bevel, and extends back,approximately 3/4 of a centimeter in length, sufficient to expose thepoint of attachment of the filament when the head of the T element isentirely housed within the needle. Before use of the needle, usually asmall puncture with a hemostat is made in the skin to free thesubcutaneous tissues, without penetrating the organ. The needle is thenused to make the initial puncture into the organ. At the time of theinitial puncture, the organ is not fixed at all, so it is important thatthe needle be quite pointed, e.g. beveled about 30°.

By having the needle hollow throughout its length, a stylette orobturator can pass down the lumen to dislodge the T after it is inplace, and during introduction, the hollow lumen is utilized to aspirateair from the stomach to prove the location of the needle tip.

In preferred embodiments, a sterile kit is provided to the physiciancomprising the percutaneous insertion needle, the "T" element, with headpreloaded in the needle, and with the filament lying alongside. Anappropriate assembly of devices is pre-arranged along the filament forapplying traction and securing the "T" element in place, preferablycomprising a compressible pledgette to bear against the body, acompression-applying retention disc to bear against the pledgette and acrimpable clamping element for permanently clamping the filament andapplying compression to the compression disc.

The method of the invention for the percutaneous fixation of organs ischaracterized by the steps of inserting a hollow needle carrying aretaining device attached to a filament, through the skin into theorgan, releasing the retaining device from the needle, and fixing theorgan by adjusting the tension on the filament and clamping the filamentby means bearing on the exterior of the body.

In preferred embodiments of this method, the retaining device comprisesa head that extends cross-wise to the filament in a "T" arrangement anda second filament is secured to one end of the head such that the headcan be removed from the organ by pulling on the second filament whilereleasing the first filament.

In preferred embodiments of manufacture of the percutaneous fixationdevice, the device comprises a hollow tubular head and a tensionfilament, the method comprising: drilling a hole in the side of thetubular head, introducing thermoplastic resin, e.g. a second filament,into the tubular head, melting the resin within the head, fusing themelted second filament to the first filament by passing the firstfilament through the side hole so that it contacts the melted resin, andallowing the device to cool.

A preferred embodiment of the percutaneous fixation device comprises: aslotted hollow needle, a "T" head element attached to a filament, thefilament being attached to the mid-portion of the head. The head ispreloaded within the slotted needle such that the filament passesthrough the slot of the slotted needle, and a set of exterior tensionapplying devices are prearranged along the length of the filament. Inanother embodiment, a second filament is attached to one end of thehead, adapted to withdraw it by releasing the first filament.

DESCRIPTION OF PREFERRED EMBODIMENTS

The drawings will first briefly be described.

FIG. 1 is a side view of a "T" element for use in the percutaneousfixation device according to the invention.

FIG. 1(a) is a sectional view of highly enlarged scale through the "T"element of FIG. 1;

FIG. 2 is a side view of a preloaded needle assembly for percutaneousinsertion of the "T" element into the body to fix the position of anorgan;

FIG. 2(a) is a plan view of enlarged scale of the needle tip region ofthe assembly of FIG. 2;

FIG. 2(b) is a longitudinal sectional view of enlarged scale through thehub region of the needle of FIG. 2;

FIG. 3--3(c) are diagrammatic representations to illustrate steps takenduring the insertion of a "T" element and subsequent manipulations forsecuring the "T" element in place to fix the stomach to the abdominalwall;

FIG. 3(d) is a view similar to FIG. 3(c) of an alternative embodiment;

FIG. 4 is a diagrammatic representation of the positioning of four tacksaccording to the invention, securing the stomach to the abdominal wallin preparation for insertion of a feeding catheter through the abdominalwall.

STRUCTURE Percutaneous fixation device (a) "T" element

Referring to FIGS. 1 and 1(a) the "T" element 8 consists of head 10 andfilamentary tension leg 12. In this embodiment, head 10 preferably haslength A, 1/4 inch, outer diameter B, 0.035 inch and rounded ends, andfilament 12 has length C, 5 inch, and outer diameter D, 0.008 inch andis highly flexible. The head is constructed to resist bending whenpulled by attached filament 12 and is radiopaque so that it can be seenwith a fluoroscope during and after insertion into the body.

In this embodiment the head is of stiff stainless steel tubing withinternal diameter E, 0.025 inch and with a central hole 14 formed in itsside of diameter F, 0.020 inch. Filament 12 is attached to head 10 byinserting a separate segment of filament 16 within and axially alignedwith head 10, heating the head to melt segment 16 with the result thatthe resinous filament melts and draws into the form of a large centralball 18, and pushing filament 12 through hole 14 into the molten ball18. When cooled and set, ball 18 is substantially larger than centralhole 14 and forms a firm root for filament 12, attaching it to head 10.Attachment of filament 12 to ball 18 also prevents the edges of thefilament from touching the portions of the tube that bound hole 14, toavoid abrasion and subsequent breakage of filament 12. Also, thegradually enlarging transition region from filament to ball serves as astrain relief. Filament 12 is preferably of nylon material such assuture material or fishing line, or of similar polymers, such aspolyester. Inner ball 18 may be of any compatible, strong material butpreferably is of the same thermoplastic material as that of filament 12to ensure good bonding, to form a strong, integrated structure.

(b) Percutaneous introductory device

Referring to FIG. 2(a), head 10 of the "T" element is inserted into thetip of hollow insertion needle 30 which has a longitudinal slot ofapproximate length I, 0.3 inch in its tubular wall. Filament 12 passesthrough slot 32 and bends back in the proximal direction. In oneembodiment a second filament 34 is attached to one end of head 10. Thissecond filament is provided as a means for removing the head of aninserted "T" element from the body after use (see below). Preferablyfilament 34 is of material similar to filament 12 and is attached tohead 10, through a hollow end of the head, at the same time as filament12 is attached, when ball 18 is molten.

Needle 30 has a sharp tip, a length suitable to permit percutaneousinsertion (e.g. 5 inches for stomach tack purposes) and an internaldiameter G great enough to accept head 10 so that head 10 is entirelywithin the needle when the needle is thrust through the flesh and theorgan wall. Preferably needle 30 is 16 gauge, small enough in externaldiameter H that it can be percutaneously introduced and penetrate theskin and flesh of the patient and the wall of the desired hollow organ(e.g. the stomach) without bending.

Referring to FIG. 2 the two filaments 12 and 34 and needle 30 areinserted through compressible pledgette 36 such that the filaments runalongside the exterior of the needle. Pledgette 36 is preferably of asoft, absorbent, spongy material such as cotton or methylcellulose, andacts as a cushion against the skin and as an absorbent for fluids. Thefilaments also ass through retention washer 38, and crimpable clampdevices 44 and 46. Filament 12 also passes through plastic tube 48 whichacts as a temporary clamping site (see below). (In another embodiment,FIG. 3d, filament 12 passes through a second crimpable clamp device 70,between device 44 and retention washer 38, which can be used to resetthe device should it loosen over time after device 44 has been initiallyclamped). Washer 38 is of material such as acrylic or a similar plasticor of metal, of approximate thickness 0.060", sufficiently stiff totransmit retention stresses between filament and pledgette. Plastic tube48 must be of a material which satisfies two different requirements, (i)sufficiently supple in the direction of its diameter so that it can besqueezed by a clamp to grip the filament within it, and (ii) strong incompression to temporarily axially bear upon device 44 and via device44, upon the pledgette, to apply tension and fix "T" element 8 in place.For example, tube 48 may be of polyethylene, vinyl, or other flexiblepolymer tubing of suitable wall thickness. Tube 48 is of length K,approximately 1 inch. Crimp rings 44, 46, and 70, are preferably ofaluminum so that they are readily fixed in place using common medicalinstruments that apply clamping pressure (e.g., a hemostatic clamp).

Referring to FIG. 2, needle 30 ends at a leur lock fitting at hub 50,into which syringe 52 with plunger 56 may be inserted. Referring to FIG.2b, obturator or stylette 54 is placed within needle 30 with one endnear to or touching head 10 of the "T" element 8, and the other endextending through hub 50. The proximal end 55 of obturator 54 is ofsufficient width, N, greater than the internal diameter, M, of needle30, that it is unable to pass through needle 30, so that it serves as astop. Obturator 54 is of sufficient length to extend from the distal endof needle 30 approximately 1 inch into syringe 52. When plunger 56 ofsyringe 52 is pushed fully down it can engage the proximal end ofobturator 54 and eject head 10 from the distal end of needle 30, bymoving obturator 54 distance J, approximately the length of head 10 plusany distance provided between the tip of the needle and head 10. (Ifdesired obturator 54 may instead by moved distance J by pushing it witha finger).

METHOD OF INSERTION

Prior to insertion of the "T" element 8 of the percutaneous fixationdevice into the stomach according to this embodiment, a nasogastric tubeis passed and the patient given intravenous glucogon to temporarily stopthe motion of the gastro-intestinal tract and thus make it easier todistend the stomach. An air pumping bulb is then attached to thenasogastric tube and air is carefully pumped into the stomach. When thestomach is moderately distended, site 72 (FIG. 4) is chosen, at which acatheter is to be inserted through the skin and an area of approximately2 inch square around the site is infiltrated with local anaethesia. Thepoints 74 (FIG. 4) for introduction of the heads of the percutaneousfixation devices (usually four in number) are chosen and marked.

Referring to FIG. 3, needle 30 containing the head 10 of the "T" element8 is filled with liquid by the syringe and the percutaneous fixationdevice is inserted through skin and flesh 62, across intraperitonealspace 66 and through stomach wall 60 into the stomach cavity 64.Insertion is followed using a fluoroscope to ensure that needle 30 iscorrectly positioned. If desired, needle 30 may be filled with anappropriate liquid, such as radiopaque material. If this is done, thenthe movement of needle 30 into the body is more easily followed with thefluoroscope. When the tip of needle 30 is within the air-containingstomach, by moving the plunger of the syringe proximally, air bubbleswill enter needle 30 and the attached syringe. Observance of these airbubbles will aid the inserter in confirming insertion into the stomachcavity (FIG. 3).

Referring to FIG. 3(a), head 10 of the percutaneous fixation device isremoved from needle 30 by insertion of obturator 54 into needle hub 50and gently pushing obturator 54 down distance J (FIG. 2b) until itsdistal end is next to the distal end of needle 30 (FIG. 3(a). The head10 may be displaced using the syringe as shown in FIG. 2(b). Once head10 has been displaced into the stomach space, needle 30 may be removed.

Referring to FIG. 3(b), by pulling on filament 12, head 10, engagedcross-wise upon the stomach wall, can be used to pull stomach wall 60towards abdominal wall 62 until they touch. Head 10 is then secured bypushing pledgette 36 along filament 12 with washer 38 until theindentation of the skin by the pledgette indicates a safisfactorytension on filament 12. Washer 38 and pledgette 36 are then secured inplace temporarily by clamp 68 applied to tube 48.

Referring to FIG. 4, the remaining percutaneous fixation devices 74, areinserted and fixed in a similar manner to the first one and the tensionon each of filaments 12 adjusted. Then each is more permanently clampedby crimping the crimpable clamp devices 44 (FIG. 3(c)). (The devices areusually placed distance L, e.g. 1", apart around site 72, the proposedsite for insertion of the catheter (FIG. 4).) The parts of thepercutaneous fixation device apparatus proximal of the crimped device 46may then be removed and filament 12 cut to an appropriate length (FIG.3(c)). Device 44 may be clamped at this point to ensure the availabilityof filament 34 for utilization at a later time. (see below).

Referring to FIG. 3(d), in an alternative embodiment a second crimpabledevice 70 may be provided for later adjustment of the tension onfilament 12. For example, if the tension slackens, filament 12 may bepulled through crimpable device 70 and then device 70 is fixed toreposition pledgette 36 more inwardly along filament 12, see FIG. 3(d)dotted lines.

REMOVAL OF TACK AND REMAINDER OF PERCUTANEOUS FIXATION DEVICE

Referring to FIGS. 3(c) and (d), the percutaneous fixation devicesnormally remain in place until the stomach wall and skin have adhered toeach other (2-3 weeks). At this point the percutaneous fixation devicesmay be removed either by cutting filament 12 and allowing head 10 topass through the intestinal tract of the body or, if filament 34 ispresent, filament 12 may be cut to release it from clamp 44 or 70 andhead 10 may be pulled through the skin using filament 34. Becausefilament 34 is attached to the end of the head, tension on filament 34causes the head to turn to align itself with the filament and theexiting opening, thus to facilitate end-wise movement of the head.

MANUFACTURE OF THE PERCUTANEOUS FIXATION DEVICE

Referring to FIG. 1(a) hole 14 of diameter F is drilled into one side oftubular head 10 near to its mid point. Filament 16 of strongthermoplastic is introduced into head 10 and the head is heldhorizontally with hole 14 pointing upward. The head is then heated in aninert atmosphere (for example nitrogen gas) to a temperature above themelting temperature of filament 16 but below the annealing temperatureof the stainless steel of head 10. Using a nylon filament a temperaturebetween 500°-600° F. is suitable. Preferably head 10 is heated using asoldering iron applied to its mid region, on the side opposite of hole14. When filament 16 has melted, filament 12 of the same material isintroduced through hole 16 and pushed into molten ball 18. If to beemployed, filament 34 is also inserted at this time throughone end ofhead 10 and pushed into molten ball 18. The assembly is then permittedto cool.

Once molten ball 18 and the filament are bonded together, pledgette 36,washer 38, tube 48, and clamping devices 44, 46, and 70 are threaded inappropriate order along filaments 12 and 34. Each of these pieces has ahole just greater in diameter than the respective filament, i.e.approximately 0.010". Head 10 is inserted into hollow slotted needle 30such that filament 12 passes through the slot and the attached end offilament 34 is at the distal end of needle 30. The whole apparatus maybe gas sterilized.

USES

The percutaneous fixation device is useful for the fixation or anchoringof hollow organs without the need for a complex operation, or the needto engage a surgeon. Organs such as the stomach, kidney, gall bladder,large and small bowel, urinary bladder, and duodenum may be readilymoved within the body to any desired position simply by inserting "T"element 8 of the percutaneous fixation device into the organ andadjusting the tension on attached filament 12. Once fixed in place,catheters are readily inserted into the desired organ. Since thepercutaneous fixation device may be readily removed, using filament 34,there is no problem with leaving the head of the percutaneous fixationdevice within the body, though in certain cases the elimination systemof the body may be employed to remove the head, and in still other casesthe head may be left permanently in the body.

What is claimed is:
 1. A method for the fixation of a hollow organ of aliving body to a body wall comprising:percutaneously inserting a rigidhollow needle carrying a retaining device attached to a trailing tensionfilament, through the skin, from outside the body, into said holloworgan in the manner that a portion of said trailing tension filamentremains outside of the body, said retaining device having a portionadapted to engage and apply pressure to an interior wall of said holloworgan, releasing said retaining device within said hollow organ fromsaid needle, pulling a portion of said trailing tension filament fromoutside the body to draw said retaining device against the interior wallof said hollow organ to pull said organ against the body wall, andfixing said organ by adjusting the tension on said filament and clampingsaid filament outside the body by means bearing upon the exterior of thebody.
 2. The method of claim 1 wherein said retaining device comprises ahead that extends cross-wise to said filament in a "T" arrangement uponrelease from said needle.
 3. A percutaneous fixation device suitable tofix the position of a hollow organ within a body which comprises:ahollow needle; and a "T" head, wherein said head comprises a stiffhollow tube having a hole in its side, a root mass of resinous materiallarger than said hole disposed within said tube, a tension filamentattached to the mid-portion of said head, said head dislodgedly heldwithin said needle, said filament extending through said hole and bondedto said mass, with said filament extending back with said needle, andmeans threaded on said filament for bearing with compression against thebody to apply tension to said filament to draw said head against theinner surface of said hollow organ.
 4. A retaining element adapted forinsertion by a needle and eventual removal through the passage formed bysaid needle, comprising an elongated stiff head, a primary flexibletension filament secured to said head, and a secondary tension filamentsecured to an end of said head, adapted to be pulled upon to withdrawsaid head end-wise upon release of tension on said first tensionelement. .Iadd.
 5. A percutaneous fixation device suitable to fix theposition of a hollow organ within a body, comprising:a "T" headcomprising a stiff member, an elongated, relatively more flexibleprimary tension filament secured at the mid-region of said head, saidelongated primary tension filament having a free end trailing back fromsaid head, and compressible means threaded on said elongated primarytension filament for bearing in a cushioning manner with compressionagainst the skin of the body, and means for pressing upon saidcompressible means while clamping said primary tension member to applytension to said primary tension filament to draw said head against theinner surface of the hollow organ. .Iaddend. .Iadd.6. The primaryfixation device of claim 5 wherein said device is adapted for insertionthrough a passage, and further comprises a secondary tension filamentsecured at an end of said head, adapted to be pulled upon to withdrawsaid head endwise upon release of tension on said primary tensionfilament. .Iaddend. .Iadd.7. The percutaneous fixation device of claim 5or 6 wherein said head comprises a hollow tube having a hole defined inits side wall, and said primary tension filament extends through saidhole. .Iaddend. .Iadd.8. The percutaneous fixation device of claim 5 or6 wherein said head comprises a stainless steel tube having a holedefined in its side wall, and said primary tension filament extendsthrough said hole. .Iaddend. .Iadd.9. The percutaneous fixation deviceof claim 5 or 6 wherein said compressible means comprises a compressiblecushioning element and a retention member. .Iaddend. .Iadd.10. Thepercutaneous fixation device of claim 9 wherein said compressiblecushioning element comprises an absorbent for fluids. .Iaddend..Iadd.11. The percutaneous fixation device of claim 5 or 6 wherein saidmeans for pressing upon said compressible means comprises:a crimpableelement in a first state adapted for sliding movement along said primarytension filament, toward said head, in a manner for application ofcompressive force upon said compressible cushioning element, and in asecond state adapted for engagement upon said primary tension filamentfor maintaining said compressible cushioning element in a compressivestate, and a clamping element in a first state adapted for slidingmovement along said primary tension filament, toward said head, in amanner for application of compressive force upon said compressiblecushioning element, and in a second state adapted upon application ofradially directed force upon said clamping element for engagement uponsaid primary tension filament for maintaining said compressiblecushioning element in a compressive state. .Iaddend. .Iadd.12. A methodfor the fixation of a hollow organ of a living body to a body wallcomprising: inserting a retaining device attached to a trailing tensionfilament, through the skin, from outside the body, into the hollow organin the manner that a portion of said trailing tension filament remainsoutside of the body, said retaining device having a portion adapted toengage and apply pressure to an interior wall of the hollow organ,releasing said retaining device within said hollow organ, pulling aportion of said trailing filament from outside the body to draw saidretaining device against the interior wall of the hollow organ to pullthe hollow organ against the body wall, and fixing the hollow organ byadjusting the tension on said filament outside the body. .Iaddend..Iadd.13. The method of claim 12 wherein said retaining device comprisesa head that extends cross-wise to said filament in a "T" arrangementupon release within the hollow organ. .Iaddend. .Iadd.4. A percutaneousfixation device suitable to fix the position of a hollow organ within abody which comprisesa tension filament having a distal end destined forthe interior of the organ and a trailing portion extending in usagethrough an adjacent wall of the body and terminating outside theexterior of the body, a cross bar attached to the distal end of saidfilament so as to form a "T" head for forcible engagement of the innersurface of the organ, and a fastener connected to said filament forsecuring the trailing portion of said filament on the exterior of thebody under tension so as to draw the organ toward the adjacent wall..Iaddend. .Iadd.15. The device of claim 14, wherein said fastenercomprises means for bearing against the exterior of the body. .Iaddend..Iadd.16. The device of claim 15, wherein said fastener furthercomprises means for fixing the position of said bearing means along thetrailing end of said filament. .Iaddend. .Iadd.17. A method of securinga hollow organ within a body to a wall of the body in preparation forinsertion of a catheter through the wall into the interior of the organ,comprising the steps ofselecting a site for catheter insertion on theexterior of the body, inserting a first retaining device from outsidethe body through the body wall into the hollow organ at a position onthe exterior of the body nearby but displaced from said catheterinsertion site, said retaining device having a head portion adapted toforcibly engage an interior wall of the hollow organ and a trailingtension filament attached to said head portion extending through theorgan and body walls outside of the body, pulling the trailing filamentfrom outside the body to draw said retaining device against the interiorwall of the hollow organ to pull the hollow organ against the body wall,fixing the hollow organ by adjusting the tension on said filamentoutside the body, and repeating the steps of inserting, pulling andfixing with a plurality of similar retaining devices at other positions,said other positions together with the position of said first retainingdevice surrounding said catheter insertion site. .Iaddend. .Iadd.18. Themethod of claim 17, wherein four of said retaining devices are used in asquare configuration centered on said catheter insertion site. .Iaddend..Iadd.19. A method for the fixation of a hollow organ of a living bodyto a body wall comprising:percutaneously providing a tract from outsidethe body through the skin and into the hollow organ, inserting aretaining device attached to a trailing tension filament, through thetract from outside the body, into said hollow organ in the manner that aportion of said trailing tension filament remains outside of the body,said retaining device having a portion adapted to engage and applypressure to an interior wall of said hollow organ, releasing saidretaining device within said hollow organ from said tract, pulling aportion of said trailing tension filament from outside the body to drawsaid retaining device against the interior wall of said hollow organ topull said organ against the body wall, and fixing said organ byadjusting the tension on said filament. .Iaddend.